Set up electronic claim/RA file sharing
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires that all health care providers and payers must use the X12 5010 version to exchange EDI business data.
Electronic data interchange (EDI) setup
We accept EDI files through a direct connection via SFTP (secure file transfer protocol, also known as FTP over secure shell) and through clearinghouses.
Priority Health doesn't publish companion guides, as we strictly adhere to HIPAA standards. Refer to Washington Publishing for X12 guides.
- To submit claims electronically: Print the Electronic Claim (837) Registration form, complete and email it to the Priority Health EDI team at email@example.com.
- To receive the 835 Payment/Remittance Advice electronically: Submit an Electronic Remittance Advice (835) Registration form online.
- To sign up for service receipts: Complete and submit the Service receipt registration form.
Claim service receipts
Service receipts summarize the number of claims submitted to Priority Health, including upfront rejections.
- They are sent directly to your office by email, fax or US mail, as selected by your office.
- The report lists any claims rejected up front for invalid or missing data elements.
Transaction types available for EDI
- 270, Eligibility requests, batch and real time
- 271, Eligibility responses, batch and real time
- 276, Claim status requests, batch and real time
- 277, Claim status responses, batch and real time
- 277CA, Claim acknowledgment
- 278, Authorizations
- 834, Group enrollment
- 835, Payment/Remittance advice
- 837P, 837I and 837D, Claims
- 999, Functional acknowledgements
Real-time transaction exceptions
Eligibility and claim status transactions are both available 24/7, with these exceptions:
- Regularly scheduled maintenance periods, which occur on the second weekend of each month.
- Non-routine downtime periods, which are published a week in advance.
- Unscheduled downtime periods, which are communicated within an hour directly to clearinghouses and/or trading partners who utilize real time services.
Email the Priority Health EDI team at firstname.lastname@example.org.
Also in this Provider Manual:
- Check patient eligibility
- Plans & benefits
- Medical policies
- Billing & payment
- Set up electronic claims
- Set up electronic funds transfer (EFT)
- Check claim status
- Reviews & appeals
- Requirements & responsibilities
- Clinical resources
- Fraud, waste & abuse policy
- News & education
- Request an online account
- Join our networks